Manila Research Articles

The level of knowledge, attitude and practice on antibiotics among selected community pharmacists and its possible contribution to the prevalence of antibiotic resistance in Manila, Philippines

Antibiotics offer lifesaving benefits and definitive treatments for infections caused by pathogenic bacteria. However, their efficacy has significantly decreased with the occurrence of antibiotic resistance due to the inappropriate use of antibiotics. Thus, the study aims to determine the possible contribution of community pharmacists to the prevalence of antibiotic resistance in Manila City by investigating their socio-demographic profile and their level of knowledge, attitude, and practice (KAP) regarding antibiotic use. This descriptive cross-sectional study utilized a pre-validated questionnaire to identify the socio-demographic and level of KAP of 150 respondents who were selected through convenience sampling. Notably, 119 (79.3%) of the respondents were female, and 82 (54.7%) out of 150 community pharmacists belong to the age group 30 and below. The majority of 146 (97.3%) respondents have Bachelor’s degrees, and 66 (44%) respondents had been in practice for less than or equal to five years. Statistical results showed that the respondents have sufficient knowledge with a total mean score of 8.18, high confidence with a mean rating for attitude of 4.79, and good practice with a mean rating of 4.52 regarding antibiotic use. Age, Gender, and Years of practice (p>0.05) were found to be correlated with their KAP level. However, the respondents’ highest educational attainment did not significantly affect practice. Overall, there is a significant correlation between the majority of socio-demographic and the respondent's level of KAP. In contrast, there is no significant relationship between the respondents' KAP as a whole. This study implies that there is only a low contribution of community pharmacists’ knowledge, attitude, and practice to antibiotic resistance in Manila City.

Making Asian Cities Greener: A Tool to Measure Environmental Performance Over Time and a Method to Implement a Green City Action Plan

This paper uses the IHS Green City Conceptual Framework (IHS-GCCF) to present and discuss the development and application of a tool to measure Environmental Performance (EP) over time applied to ten Asian cities and a method using these results to implement a Green City Action Plan (GCAP) applied to the city of Manila. The tool measures EP over time and helps to explain possible factors contributing to the variation of the EPs in the studied time. The GCAP uses the EP results to develop a green city action plan to improve the current EP for a given period. Both tool and method fulfil gaps found in the green city literature, contain innovative approaches, and help cities to measure and plan improvements in their current EP. By applying the EP tool to ten Asian cities in two periods (2007–2009 and 2015–2018), the paper shows that Singapore and Hong Kong had the highest EPs and Bangalore had the lowest. Implementation of water management and climate change strategies are some factors explaining the improvement in Hong Kong's EP. A strong increase in population size is behind the EP reduction in Bangalore. The Manila GCAP proposes to improve the current EP of the city from 15.43 to 17.41 in twelve years.

The global response: How cities and provinces around the globe tackled Covid-19 outbreaks in 2021.

BackgroundTackling the spread of COVID-19 remains a crucial part of ending the pandemic. Its highly contagious nature and constant evolution coupled with a relative lack of immunity make the virus difficult to control. For this, various strategies have been proposed and adopted including limiting contact, social isolation, vaccination, contact tracing, etc. However, given the heterogeneity in the enforcement of these strategies and constant fluctuations in the strictness levels of these strategies, it becomes challenging to assess the true impact of these strategies in controlling the spread of COVID-19.MethodsIn the present study, we evaluated various transmission control measures that were imposed in 10 global urban cities and provinces in 2021– Bangkok, Gauteng, Ho Chi Minh City, Jakarta, London, Manila City, New Delhi, New York City, Singapore, and Tokyo.FindingsBased on our analysis, we herein propose the population-level Swiss cheese model for the failures and pitfalls in various strategies that each of these cities and provinces had. Furthermore, whilst all the evaluated cities and provinces took a different personalized approach to managing the pandemic, what remained common was dynamic enforcement and monitoring of breaches of each barrier of protection. The measures taken to reinforce the barriers were adjusted continuously based on the evolving epidemiological situation.InterpretationHow an individual city or province handled the pandemic profoundly affected and determined how the entire country handled the pandemic since the chain of transmission needs to be broken at the very grassroot level to achieve nationwide control.FundingThe present study did not receive any external funding.

Spatial point pattern analysis of drug related crimes in October 2017 in Manila City

ABSTRACT Many studies and statistical reports presented by anti-drug agencies in the Philippines suggest that illicit drug use in the Philippines had been increasing substantially. This study aims to analyse the locations of drug-related incidents in Manila City in October 2017 through the analysis of spatial point patterns. The point pattern for drug-related crimes was then tested for spatial dependence with specific establishments in Manila City such as schools, churches, and police stations. Notable results presented in this paper are: (i) the imposition of Philippine Drug Enforcement Agency to handle all drug-related crimes had significantly decreased the number of reported drug crimes, (ii) drug-related crimes were clustered on residential areas, (iii) drug-related crimes were inclined to happen far from colleges and universities, and (iv) drug-related crimes happened more frequently near public high schools.

Analyzing the Service Quality of E-Trike Operations: A New Sustainable Transportation Infrastructure in Metro Manila, Philippines

The electric tricycle, often known as an e-trike, is a three-wheeled electric vehicle designed to transport a small group of people over short distances on side streets. This study aims to develop a service quality model of sustainable e-trike operations in the city of Manila, Philippines using stepwise regression analysis. A total of 230 participants from three districts in the City of Manila: Binondo, Recto, and Intramuros, were selected using the stratified sampling method. The main contribution of this study emerges from the quantification of the influence of sustainability indicators on the perceived service quality of e-trike passengers. The study identified 10 indicators: PWD accessibility (β = 0.2128), smoothness of the ride (β = 0.1001), noise level (β = 0.0886), discount rate (β = 0.0886), land use (β = 0.0835), comfort load (β = 0.0723), fare acceptability (β = 0.0577), e-trike intensity (β = 0.0420), fare affordability (β = 0.0339), and ease of availability (β = 0.0317) have significant importance in the service quality of e-trike operations. These indicators revealed the areas where improvements are needed to ensure the long-term viability of e-trike operations. Therefore, it is concluded that these factors should be the focus and priority for the improvement of e-trike operators, drivers, and transport groups to attain sustainability of e-trike operation in the country. Moreover, this study can also be used for other public transportations to improve their current service quality and operations.

Development of a salivary IgA detection method for accurate diagnosis of amebiasis.

An amebiasis detection method was developed based on identifying anti-Entamoeba histolytica IgA in the saliva of infected individuals. The enzyme-linked immunosorbent assay (ELISA)-based detection method was tested along with microscopy and polymerase chain reaction (PCR) on saliva and stool samples from 110 asymptomatic individuals visiting the Manila Health Department - Public Health Laboratory of the City of Manila, Philippines. A receiver operating curve (ROC) was constructed to compare the ELISA results with PCR results. E. histolytica infection was detected in 18 of the 110 individuals. The developed method had an accuracy of 90%, sensitivity of 88.89%, specificity of 90.22%, positive predictive value of 64%, and negative predictive value of 97.65% if a 1:2 dilution of crude saliva sample in phosphate-buffered saline (PBS) was used for diagnosis when compared to PCR. The area under the curve (AUC) of the ROC was 0.9436 if a 1:2 dilution of a crude saliva sample was used. The developed assay presents an easy and accurate method of detecting amebiasis in infected individuals using saliva samples instead of stool or blood samples and has potential applications in both diagnosis and epidemiological studies.

Prevention of Fetal Neural Tube Defect with Folic Acid Supplementation

Prevention of Fetal Neural Tube Defect with Folic Acid Supplementation

Coping Strategies and Job Satisfaction among Rehabilitation Medical and Paramedical Staff in a COVID-19 Referral Center: A Cross-sectional Study

Objectives. The objective of this study was to determine the coping strategies and job satisfaction among rehabilitation medical and paramedical staff deployed to different areas at the University of the Philippines Manila Philippine General Hospital, a designated COVID-19 referral center.
 Method. This was a cross-sectional study that utilized total population sampling of the medical and paramedical staff of the Department of Rehabilitation Medicine deployed to other areas in PGH and who carried out non-rehabilitation-related clinical work responsibilities during the COVID-19 pandemic. Electronic informed consent was obtained from each participant. Two sets of validated and reliable self-administered online questionnaires, namely, the Brief Coping Orientation to Problems Experienced (COPE) Inventory Tool and Satisfaction of Employee in Health Care (SEHC) Survey, were used to determine coping strategies and work satisfaction, respectively. Descriptive statistics (such as frequencies, percentages, ranges, means) were used to present the data.
 Results. A total of 50 medical and paramedical staff participated in the study. The participants’ age ranged from 22 to 60 years (mean: 30.2 ± 8.7). The majority were single (84%), women (64%), and with a Bachelor of Science degree. Most of the participants were assigned in the orange zone, which included the COVID ward nurses’ station and donning/doffing areas; with 30% who rotated in the COVID wards. There were three types of coping strategies utilized by the department staff: (1) emotion-focused coping, (2) problem-focused coping, and (3) dysfunctional coping. Problem-focused coping was the most common general strategy (mean COPE score for all problem-focused strategies, 3.1 ± 0.9). Acceptance was the most common specific coping strategy, followed by active coping and a tie among positive reframing, planning, and self-distraction. The work satisfaction rate was at 76.9% ± 13.2. Three out of 4 participants would recommend their workplace to other healthcare workers.
 Conclusion. The medical and paramedical staff of the Department of Rehabilitation Medicine in a COVID referral center had relatively high job satisfaction despite their health risks and changes in responsibilities among others. The majority utilized functional coping strategies to help them adapt to the work demands. The sources of motivation and values of the staff are areas for future research to help explain their positive outlook about their jobs and generally high recommendation about their workplace in the middle of the COVID-19 crisis.

Characterization, source apportionment and associated health risk assessment of respirable air particulates in Metro Manila, Philippines

Coarse (PM10) and fine (PM2.5) aerosols were sampled from June to November 2016 at three different sites in Metro Manila Philippines (Valenzuela, NAMRIA, and MMDA). PM2.5 average levels in all sites exceeded the World Health Organization annual and daily limits, indicating that the ambient air qualities in all sites were unhealthy. Black Carbon (BC), a fingerprint of incomplete combustion, constituted 31–46% of PM2.5. Multi-element analysis of PM indicated that the sulfur, lead, and zinc had substantial contributions to PM2.5, with the highest level found in Valenzuela. Receptor modeling highlighted six important sources: vehicular emissions, biomass burning, industrials, secondary sulfur, sea spray, and fine soil. Among the sources, vehicular emission was the most dominant source, comprising 20–35% of the apportioned sources. An industrial source, predominantly with Zn and Pb, was seen in Valenzuela, contributing about 5.4% of its PM2.5. The health risks of fine aerosol, BC, and major elements were evaluated also in this study. Elements studied showed negligible potential (HQ < 1) to cause non-carcinogenic health effects and very low (<1 × 10−6) carcinogenic health effects to children and adults. The observed trend for carcinogenic risks of PM2.5 in children was Valenzuela > MMDA > NAMRIA while a medium carcinogenic risk was observed for adults at all sites (CR > 1 × 10−5). The trend for PM2.5 average HQ values in both age groups was Valenzuela > MMDA > NAMRIA. Our results showcased varying levels and sources of PM and its components that can impact the health upon exposure and should be addressed in future policies to safeguard public health.

The Effect of Non-Price Policies on Household Tobacco Consumption Among the Filipino Youth in City of Manila

Tobacco consumption, including cigarette smoking, has a significant and increasing global public health burden. Despite recent declines in incidence, its adverse effects on human health increases the risk of several cancers. This study explained the non-price strategies that directly influence smokers' intake and initiation and the problem of long-term tobacco exposure by second-hand smokers and those affected by the media or their environment. Higher cigarette taxes and tighter regulations and enforcements, restricting who can purchase tobacco products, are prevention examples that equate to the cessation process. The research contributed to the area of study regarding the optimal control on tobacco use since it examined the findings of the performed survey to understand the influence of non-price strategies such as graphic health warnings on the young smoking intention. To substantiate the relationship between non-price policies and tobacco usage, it explores the purposively selected participants for the study, Filipino male or female youth smokers and non-smokers with an age qualification between 15 and 30 years old. The study illustrates that to promulgate awareness regarding the risks of vicious substance intake, the government must implement substantial compliance and aversion through specific indicators from this research model. Keywords: Youth, tobacco consumption, cessation, risk aversion, illness, health warnings, tobacco policies, smoking

Characterizing Awareness of Pre-Exposure Prophylaxis for HIV Prevention in Manila and Cebu, Philippines: Web-Based Survey of Filipino Cisgender Men Who Have Sex With Men.

BackgroundThe Philippines is experiencing an HIV crisis and is considering implementing pre-exposure prophylaxis (PrEP) as a national public health strategy for HIV prevention for cisgender men who have sex with men (cis-MSM). However, critical information on the awareness of PrEP among cis-MSM is needed to roll out this public health initiative.ObjectiveThis study aims to assess PrEP awareness and related correlates (ie, sociodemographic variables, social factors, and health care access and use) among Filipino cis-MSM.MethodsWe conducted a web-based survey with Filipino cis-MSM (n=179) residing in the cities of Manila and Cebu, Philippines. Multivariable analysis procedures were performed to examine the factors associated with PrEP awareness.ResultsOur sample demonstrated high awareness (134/179, 74.9%) and interest (159/179, 88.8%) in taking PrEP. The adjusted model showed that greater odds of PrEP awareness were associated with having a college education or higher versus a high school education or lower (adjusted odds ratio [aOR] 7.30, 95% CI 1.01-52.47), earning between PHP 10,000 (US $198.6) and PHP 20,000 (US $397.2) versus <PHP 10,000 (US $198.60; aOR 9.32, 95% CI 1.41-6.22), having had a prior HIV test (aOR 6.06, 95% CI 1.20-13.55), having high HIV knowledge (aOR 3.50, 95% CI 1.11-10.98), and having friends who discussed PrEP (aOR 11.17, 95% CI 2.73-14.5).ConclusionsOur findings demonstrate that Filipino cis-MSM are aware of and interested in taking PrEP, but there is currently an unmet need for such biomedical HIV prevention technologies among this population. Incorporating PrEP education into routine HIV screening and leveraging cis-MSM social networks may be useful in optimizing potential PrEP implementation in the Philippines.

A Cross-sectional Study on Factors of Well-being of UP College of Medicine Students from SY 2017-2018.

Psychological distress is more prevalent among medical students compared to the general population. This study describes the factors which contribute to the well-being of medical students enrolled in the UP College of Medicine, and their relationship with the students' demographic characteristics. The modified Cardiff Medical School Well-being Questionnaire was administered to 598 students of the UP College of Medicine. The following domains were explored: acquisition of knowledge and skills, work-life balance, demands, travel and orientation, safety, culture, finances, perceived support in academics and perceived support in personal/health matters. Students also shared their insights regarding potential areas of change to enhance their engagement and performance. Demographics are presented as frequency and percentage; the relationship between the demographic characteristics and factors was analyzed through multiple linear regression. The mean age of the medical student participants was 22.6 years, with an almost equal male to female ratio. The majority were single, Roman Catholic, lateral entrants, having a high socioeconomic status, and with residence in the City of Manila while in training. Medical students were least concerned about culture, safety at work, travel and orientation, and perceived support for academics. However, they were most concerned about work-life balance, demands, finance, and perceived support on personal and health matters. Medical students expressed more concern about work-life balance, demands, finance, and perceived support on personal and health issues, and marked less concern about culture, safety at work, travel and orientation, and perceived support for academics. Across all domains, there are areas for improvement and limitations which can be further explored in future studies.

A Cross-sectional Study on the Sleep Quality and Excessive Daytime Sleepiness of Filipino Medical Students in a State-run University during the Coronavirus Disease (COVID-19) Pandemic.

Movement restrictions and changes in medical education around the world due to the Coronavirus 2019 pandemic have been sources of stress, which affect sleep and compound the demands of medical education. In the Philippines, stay-at-home orders were implemented in the National Capital Region on 15 March 2020, and despite various readjustments and re-definitions, remain in effect to date, March 2022. This cross-sectional study aims to determine the sleep quality and daytime sleepiness of Filipino medical students during prolonged stay-at-home orders, to compare them with pre-pandemic evaluations, and to explore associations between scores and participant characteristics. The medical student population of a state-run university in the City of Manila was included, while those on a leave of absence were excluded. The Epworth Sleepiness Scale and the Pittsburgh Sleep Quality Index which measure excessive daytime sleepiness and sleep quality, respectively, were disseminated via Google Forms from April to May 2021. Response rate was 87.75% (n=709) with a mean age of 22.9 ± 2.0 years and a 1:1.09 male-to-female ratio. Among the respondents, 41.18% had excessive daytime sleepiness, and was significantly higher for first-year premedicine students. Compared to pre-pandemic scores, daytime sleepiness decreased during the pandemic. On the other hand, 62.34% of the respondents had poor sleep quality, with global scores being significantly higher for the first-year pre-medicine students. Relationships between participants' characteristics and their scores were extremely weak, while a moderately significant correlation existed between global daytime sleepiness and sleep quality scores. Both excessive daytime sleepiness and poor sleep quality remain prevalent during prolonged stay-athome orders. These reflect the effect of the pandemic on stress inherent to medical education, and may be additional facets to be regarded in evaluating the general well-being of medical students.

ATTITUDES OF ELEMENTARY SCHOOL TEACHERS TOWARDS ONLINE LEARNING DELIVERY IN THE TIME OF COVID-19 PANDEMIC

Educational institutions were compelled to use the world of cyberspace, specifically through the Internet as its main infrastructure, to “effectively” transmit knowledge to the learners in the middle of the COVID-19 pandemic. It is in this light that this study investigated the attitudes of elementary school teachers towards online learning during the COVID-19 pandemic. This study determined the significant difference between respondents' assessment of teachers' attitudes towards online learning when grouped according to gender, age, and teaching experience of the 138 elementary school teachers from Districts 2, 3, and 4 of Manila City. The results indicate that elementary teachers felt that online learning devices could help improve the quality of their work. Contrary to this, the face-to-face learning delivery remains favorable for them. Furthermore, the results show that it is essential to continuously develop the quality of online education with the support of school administration and government to make online education more effective and accessible to all.

Microclimatic factors and soil characteristics of Arroceros Forest Park in the City of Manila, Philippines

Abstract. Berame JS, Elazegui EP, Arenas MC, Orozco JA. 2021. 2021. Microclimatic factors and soil characteristics of Arroceros Forest Park in the City of Manila, Philippines. Biodiversitas 22: 4956-4962. Microclimatic factors affect many ecosystem functions. However, the challenge of acquiring consistent data has impeded the quantitative assessment of the spatial heterogeneity of soil-climate in Arroceros Forest Park as an artificial urban forest park known as the last lung of the City of Manila. With this unassisted urban forest park, this study aims to determine the microclimatic factors such as light intensity, air temperature, air humidity, wind speed and direction, soil temperature, soil pH, percent organic matter, percent soil moisture and soil texture by using a sieve analysis and textural triangle method to know the status of the forest park. These procedures reveal the soil type available in the park to be clay and loam suitable for growing plants abundantly. Results showed that four microclimate factors viz. air temperature, air humidity, percent organic matter, and soil texture, were highly significant (p&lt;0.000). Additionally, it further revealed that microclimatic factors such as light intensity, wind speed, and soil pH are essential in an ecosystem. It also found that soil size is a significant parameter for soil characterizations in this kind of study. Finally, the division of soil microsites into different positions based on prevailing light or shade conditions helped assess the significant variations of soil characteristics and conditions within the study area.

Sugar Sweetened Beverages (SSBs) Consumption Of High School Students In Two Selected Public Schools Of Manila City District V

Sugar Sweetened Beverages (SSBs) Consumption Of High School Students In Two Selected Public Schools Of Manila City District V

Epidemiologic Profile of Vehicular Accident Patients in the Largest Hospital in the Philippines Covering Ten Years

Introduction. Globally, the number of people who die from road crashes continues to rise, reaching a high of 1.35 million in 2016. Due to this continued increase in fatalities and injuries within the road transport system, especially in low- and middle-income countries, 2011 to 2020 was declared by the United Nations General Assembly in 2010 as the Decade of Action for Road Safety.&#x0D; Objectives. This study looked into the epidemiology of road crashes and injuries in Metro Manila over ten years, from 2008-2017, from data gathered at the Department of Surgery of the Philippine General Hospital (PGH).&#x0D; Method. A retrospective review of patients’ clinical records was conducted to describe the epidemiology of road crash cases in the Trauma Division, Department of Surgery of the PGH. Clinical records of the road crash patients admitted to the division over the ten years, January 1, 2008, to December 31, 2017, were extracted from the Integrated Surgical Information System (ISIS).&#x0D; Results. A total of 422 patients were admitted to the PGH Department of Surgery and recorded in the ISIS database, from 2008 to 2017, who suffered from road crashes in Metro Manila. Most of these patients (80.8%) were male. The mean age of patients was 32.4 years. The highest number of admissions (27.5%) and road crash deaths (6.9%) were in 2016; the highest number was from the city of Manila (26.7%), and most happened at nighttime (61.8%) between 6:00 PM and 5:59 AM. Throughout the years, motorcycle (52.8%) was the vehicle type involved. Among patients with helmet use information, 65.4% were not wearing helmets, 91.2% had a history of alcohol intake. The majority incurred multiple injuries (82.7%), with the external region (53.8%) as the most common. Patients who sustained injuries to their head and neck region were five times more likely to die and six times more likely to have an unchanged patient outcome than those who did not have these injuries. Patients who had a GCS of 8 and below or those who had severe brain injuries were eight times more likely to die and six times more likely to have an unchanged patient outcome.&#x0D; Conclusion. This study looked into the epidemiology of road crash cases admitted to the Surgery Department of the PGH. Road crash injuries and deaths remain a growing concern among the citizens of Metro Manila. It is hoped that the results of this study will provide policymakers with an objective and data-driven perspective on road crashes.

Parks, plans, and human needs: Metro Manila’s unrealised urban plans and accidental public green spaces

ABSTRACT Planned after the City Beautiful Movement and Garden City Movement, Manila City and Quezon City, now among Metro Manila’s 16 cities, did not result in the desired outcomes of their planners. The history of unfulfilled visions that began with Burnham’s 1905 Plan for Manila repeated in similar fashion in Quezon City in its 1949 Frost-Arellano Plan. How do Metro Manila’s public green spaces, as remnants of these plans, sustained specific visions for meeting human needs? To find answers, we focused on Rizal Park and the University of the Philippines (UP) Academic Oval – two public green spaces that remained from the Burnham and Frost-Arellano plans. Contemporary uses of these spaces suggest that the intermingling of the upper and lower classes as envisioned in these plans is limited; nonetheless, they represent endeavours by fairly diverse groups to actively satisfy human needs within and beyond how these spaces were initially designed.

Street vending and co-production: key lessons during the COVID-19 pandemic

ABSTRACT The COVID-19 global pandemic has prompted governments to resort to or allow quasi-formal means to provide basic goods and services to communities that were forced into quarantine. We analyze how grassroots self-help strategies interact with the adaptation mechanisms of formal governance under crisis conditions. Drawing on empirical insights in Manila (Philippines) and Hanoi (Vietnam), we examine the practices that have enabled street vendors in the two metropolises to earn a living and to provide needed services to city residents. We explain how some lessons on co-production practices might inform post-pandemic recovery strategies and future policy-making processes in global South cities.

Anti-vaxxers vs. Pro-vaxxers: An Analysis of Select Manila Residents’ Stand on COVID-19 Vaccination

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), launched the COVID-19 pandemic putting the majority of the countries on lockdown. As vaccine development pursues, the need to analyze the determinants of vaccine hesitancy among Filipinos are paramount in order to address poor vaccine uptake and boost vaccine acceptability. This study is a descriptive-comparative study that compares the stand of select Manila residents? pro-vaxxers and anti-vaxxers and the factors that affect their perspective on COVID-19 vaccination. A survey questionnaire was disseminated online to respondents who are qualified based on the following criteria: Filipinos ages 18 to 65 years old who are Manila City residents, at least secondary school graduates, are willing to be involved in the study, and have not contracted the virus nor received a vaccination for it. Out of the 189 participants of the study, 180 of which were classified as pro-vaxxers and 9 as anti-vaxxers. After analysis of data, the respondents, in general, agree that Safety and Effectivity (x=3.08), Trust (x=2.88) and Social (x=2.44) factors positively affect their COVID-19 perspective while Experiences (x=1.66), Beliefs (x=1.74), and Financial (x=2.45) factors were less likely to affect their perspectives. An unpaired t-test was also used on the factors to determine the significant difference in the perspectives of the two groups, whose results are as follows: Safety and Effectivity (p = 0.650), Trust (p = 0.033), Social (p = 0.003), Experiences (p = 0.325), Beliefs (x = 0.029), and Financial (p = 0.050). Four of these factors namely Trust, Social, Beliefs, and Financial were found to have a significant difference (p 0.05).